B A R E L Y B A D  W E B  S I T E  

The problem with Mrs. Smith's leg

On the previous page about being a claims adjuster in Chicago I talked about the nasty and dangerous Projects, and how I impersonated a detective once in order to gain access without getting mugged.  I concluded by saying that looking the part is crucial.

But looking the part, while necessary, is way less important than being confident.  Confidence is everything.  Without it you can't succeed in impersonating your own self.  With it the doors will open if you are brash enough.

If you look the part, if nothing's obviously out of place, then when you approach people they do not automatically assume you're an impostor.  Why would they?

And if you can also act the part they are even more likely to believe you are who you pretend you are -- who you must believe you are -- because why wouldn't they?  If you act like a detective, criminals will treat you like one.  If you act like a lawyer, courthouse clerks will treat you like one.  And if you act like a doctor, nurses will treat you like one.

The accident.  My most useful impersonation of a doctor arose out of one of my most memorable claims cases. Our insured driver, a grad student I'll call Beth (it's not that I'm protecting her identity, it's that I can't remember her real name), got within two blocks of her apartment on Belmont at Clark Street when she drifted off the road and up onto the sidewalk, finally coming to rest against a fire hydrant in the classic movie tradition.

After the paramedics wakened her, they told her she had mown down an old woman who had just debouched from a CTA bus.

No R/I.  I called Beth shortly after I got our first report of the accident, and she agreed to meet me in her apartment.  I arrived in the area a couple hours early, the same time of day the accident happened, to canvass for witnesses

When you go out looking for people at a busy street corner who can provide information about an accident, it's important to distinguish between those who actually witnessed it and those who know about it only through hearsay.  You want to find all such people, but you use the latter group only for investigative leads, not evidence.  When you find a real eyewitness you get a recorded interview, an R/I, right there on the spot.  Of all the disinterested witnesses I tracked down and accosted over four years of investigating various incidents, I can remember only a handful who didn't stop right then and there and agree to an R/I.  It has been my experience that almost every independent witness in the country is happy to be interviewed on tape, whether in person or by phone, and takes it seriously.

Anyway, when I went to see Beth, she let me in and told me she had changed her mind, that she wouldn't talk to me without her lawyer.  I explained that she was a holder of our auto policy and that she was required by its terms to cooperate with me.  She insisted that she wouldn't talk to me without her lawyer, and I finally agreed to meet her and him in his office the following night.

I met with Beth the next evening at her very expensive lawyer's office.  As an aside, I remember looking out of his enormous office windows and thinking what a beautiful city Chicago is at night.  As another aside, I will say that Beth was a strikingly beautiful girl.  She was also an extremely repentant girl.  I opened by saying that we, her insurance company, would provide her with all the legal assistance she needed, according to the usual provisions of an auto policy.  I went on to explain to him and her that, indeed, we insisted, and that if she got sued and didn't want to use our lawyers we would have to deny coverage.  This was the first, and last, time I ever interviewed my own policyholder in the presence of her own separate lawyer.

Now, it is the policy of Liberty Mutual to do an R/I, a Recorded Interview, of all interviews.  Part of the reason is to preserve a record of what was said, of course, and part of the reason is that it is thought, and not unreasonably, that most people, most of the time, will tend to tell more of the truth if they know their exact words are being recorded.

So I hauled out my tape recorder, preparatory to interviewing Beth, but before I could get started the lawyer said he wanted to tell me the story in brief.  Now, normally I wouldn't have allowed that, because normally I'd want to get the interviewee's story as fresh and straight from her pretty mouth as possible, but he convinced me to listen after suggesting the possibility of criminal charges, a term claims adjusters rarely hear.

He related how Beth had spent a long day at her college way out in the Northwest suburbs studying for her finals the next day.  She had faced a long drive home, and she wanted to be able to get right to sleep when she arrived, so as to be fresh in the morning.  Consequently, just as she left school she took some sleeping pills -- someone else's prescription sleeping pills.

It was partly because of her exhaustion and mostly because of the sleeping pills (duh) that she fell asleep at the wheel.

For only the second time ever, I decided not to use the tape recorder, not to take an R/I.

Her lawyer's first reason for not wanting a tape recording made was that, if she told the truth, she might well be admitting to felonies such as manslaughter if the claimant died or criminal negligence if she didn't.  A claims adjuster's tape recorded statement is not protected by any privilege I know of, and it is certainly subject to subpoena.  So are any transcripts made thereof, not to mention the testimony of the interviewer himself.

The lawyer's second reason for not wanting a tape made was that he realized that if she lied about or declined to answer any question on tape to avoid admitting criminal liability, she would be jeopardizing her insurance coverage for civil liability, because coverage can be denied if the insured driver knowingly lies to the insurance company about a material fact.

However, my reason for not recording her story wasn't either of those.

Although I left the tape recorder off, I interviewed her just the same.  Later I would dictate a report of the interview (couched as much as possible in the form of what's called "work product," about which more here later).  I asked her about being tired and taking someone else's sleeping pills in the hope that she'd be sleepy by the time she got home.  She admitted it all.  At one point I asked her, "Where were you at the last time you remember?"  She mentioned an off-ramp from Lake Shore Drive about a mile north of Belmont.  I followed up with "What do you remember next?"  It was at this point that Beth broke down in tears, remembering her realization that she'd run over a little old lady.

Top of page

Punitive damages.  What I had here was a dead-bang loser.  Not only would a jury find her guilty and award huge compensatory damages, there was a significant chance they would award punitive damages as well.

And it was because of the punitive damages that I decided not to make a tape recording, not because of any particular concern for Beth's dilemma.

Money damages awarded by a civil jury for a tort such as serving tainted food or botching a surgical operation always include compensatory damages, which means compensating the claimant for his losses.  Presumably, the amount of money equals the losses.  But in rare cases the jury can also award punitive damages, which are just what they sound like: It's a separate dollar amount, over and above the compensatory damages, whose purpose is not to help the victim but to punish the perpetrator.  Punitive damages can be awarded only when a jury is convinced the defendant's behavior was, at best, obviously dangerously and recklessly negligent.

Now, officially, according to the policy language, an insurer is not obliged to pay on behalf of an insured driver any punitive damages that a jury might award, because the nature of any act that results in punitive damages is, by definition, not covered as to the punitive damage amount.  As I saw it, Beth had committed an intentional act -- taking someone else's sleeping pills and then setting out on a long drive -- that could expose her to a hit for punitive damages by a jury.

As a matter of public policy, liability insurance is bought to protect only against accidents, not intentional acts.  If you could get insurance that covered intentional bad acts, there would be millions of people buying such insurance and then going out and maiming and killing and setting fires and God knows what else.  It's for this reason that it is also illegal in all fifty states to buy property insurance on property you don't own.  In legalese, you must have an "insurable interest" in the property, which means you stand to suffer a loss if it's damaged.  In the absence of such public policy, it would be too easy for a bad guy to buy insurance on someone else's property and then burn it down or blow it up to collect the proceeds.

But no matter what the wording of an insurance policy says, there are plenty of judges and jurors who hate to see plaintiffs not receive their full due.  In essence, they'll try to make the insurance company pay not only the compensatory damages but the punitives as well, if the defendant has no money left.  Liberty Mutual, like every other insurance company, always strove to avoid that possibility, and that's why I made the executive decision not to tape Beth's statement.  At the time I thought only of protecting my company from a jury's ever learning the full truth, and as I look back on it now, fifteen years later, I can see that I failed in my responsibility to the claimant, an innocent and maimed human being.

The initial diagnosis.  Mrs. Smith's most serious injury was a broken left leg.

Tib or fib?  As between the two bones in the lower leg, you're always better off choosing to break the fibula.  The tibia (shinbone) carries most of the weight during walking and standing.

Comminuted?  As between a comminuted fracture and a non-comminuted fracture, you're always better off choosing a non-comminuted fracture, which is where the bone is broken in twain (three pieces is "thrwain").  A comminuted fracture is one in which the bone is essentially crushed or pulverized into many small pieces.  Comminuted fractures result from a momentous collision or from a crush injury against an unyielding anvil such as a concrete sidewalk.

Compound?  As between a simple fracture and a compound fracture, you're always better off choosing a simple fracture.  A compound fracture is one in which the bone actually protrudes through the skin, and it is always a bad deal for at least four reasons.

  • First, with a compound fracture there's going to be all sorts of sewing together of the various parts that got torn, such as blood vessels and fat and muscles and tendons and ligaments and skin.
  • Second, there's obviously going to be some loss of blood, maybe more than you can live with.
  • Third -- and this is actually the most significant reason in the long run for so many patients with a compound fracture -- during the minutes between when the injury occurs and when the patient is properly protected from the world, there's all sorts of microbes that can't wait to settle into the open wound and cause an infection.
  • Fourth, to have a bone break in such a way that it actually protrudes through the skin has got to hurt like hell.

Near the top of the first page of the ER notes for Mrs. Smith appears this notation:

Ax: MVA v ped.  Dx: comp comm L tib-fib fx.
  

Nurse's notes, which are usually written in pen on a chart and never transcribed, have a notation system all their own, as you might expect.  For example, the "L" I referred to above was actually written with a circle around it, because "L" and "R" inside circles mean left and right.  "Ax" means Accident;  "Dx" means Diagnosis; "Fx" means Fracture; "Hx" means History (and "PMH" means Past Medical History, which is different), "Rx" means take (as in "take this medicine," which is probably the only one you're familiar with); and "Tx" means Treatment.  Altogether there are probably hundreds of other such signs and symbols and abbreviations used by medical personnel.

I've seen "PERLA," for example, many dozens of times on ER reports.  It means Pupils Equal and Reactive to Light and Accommodation.  If you've ever wondered why the paramedics and ER doctors on TV shows shine a light into Ax victims' eyes and so on, here's what you do: First look into both eyes to observe the size of each pupil, the dark part in the very center.  Then shine a bright light first into one eye and then quickly into the other and observes what happens.  If everything is OK, each pupil will contract in response to the extra light, and each pupil will contract equally.  If one contracts less than the other, that signals a potentially significant problem with the head.  For example, if the left pupil contracts less or not at all, that means the right side of the very brain itself might have taken a whack (in more general medical terms, an "insult") severe enough to retard or eliminate the pupil's otherwise natural and automatic reaction to extra light.  Bad deal.

You'll also remember from TV that the paramedic or the nurse asks the conscious patient to follow her finger as she moves it toward and then away from his nose and then from from side to side.  If his eyes fail to track the finger smoothly, that is, if they fail to focus normally (which is the same as failing to "accommodate"), that also signals a brain problem.  Bad deal.

A series of three questions is often asked of patients who might have suffered a LOC (loss of consciousness).  The questions relate to orientation as to person, place and time, and go something like this: "Who am I?  Where are you?  What day is it?"  If the answers are "A nurse," "St. Luke's Hospital," and "Wednesday," the nurse's notes will say, "Oriented X 3," and that's a good deal.

But if your answers go anything along these lines

"Who is this woman holding your hand and sobbing?"
"She's my niece, General George S. Patton."

"Where are we right now?"
"Jonah's ark."

"What day is it?"
"Hamster pot pie."

then you're oriented X 0.  Bad deal.

To translate, what these particular nurse's notes on Mrs. Smith's admission through the ER mean is that as a result of a motor vehicle versus pedestrian accident the diagnosis was a compound, comminuted fracture of the tibia and fibula of the left leg.

If you read the part above you now know that for Mrs. Smith it could not have been a much worse leg fracture.

Control.  It was easy to track down Mrs. Smith in the hospital.  She was a really nice lady, considering what my insured had done to her, and I managed to achieve what's called "control" of her right away.  I can't speak for other insurance companies on this subject, but I can tell you as to Liberty Mutual that getting control early on is paramount.  A "controlled claimant" is one who hasn't hired a lawyer, and Liberty adjusters go to great lengths to acquire and maintain that control.  In this claimant's case I wrote her a check for $1,000 (the most I could pay using that checkbook) on the spot and I told her I'd be getting another $6,500 to her to her right away (the most I could spend on any one claimant was $7,500 without getting authorization from my supervisor's supervisor).

I told her I knew her medical expenses would likely amount to more than that and that as the bills arrived I "would give full consideration" to paying them "right away."  Throughout my many discussions with her over a period of a few months, I never flat-out admitted our insured driver's guilt, but I always made it clear that I'd be paying for everything that was "reasonable, necessary and directly related" to the accident.

On one of my visits to her hospital room she said her son had recommended that she get a lawyer, so I went into my explanation why that was a bad idea:

"Mrs. Smith, you need to understand that the monetary value of your claim will not change just because you hire a lawyer.  Your medical expenses and your pain and suffering are worth what they're worth regardless of whether you're represented.  The only thing that will change is the amount you walk (or roll, as it turns out) away with.  If you hire a lawyer he'll take one third of what I pay you as his fee, whereas if you continue to trust me you'll end up with 100% of the value, not just 67%."

And trust me she did.

By the time I got to her Mrs. Smith had already undergone what's called a "fracture reduction."

  • In a closed reduction, the bone pieces are aligned from the outside, by simple manipulative pressure: You grab one of the bone pieces through the skin and muscle, you or someone else grabs the other one, and you haul them back into place (following which you typically place a cast on the area so the bone pieces will remain stationary till they start to heal back together).  It's called "reducing the fracture" because you're reducing the misalignment between the two bone pieces, presumably to zero.  In fact, when a radiologist examines an X-ray of a correctly aligned fracture he'll say something like, "The fibula displays anatomical alignment," meaning the displacement has been reduced completely.  When the bones are fully fused the radiologist refers to the site as a "well-healed fracture."
      
  • An open reduction, however, is a much bigger deal.  It's surgery, with scalpels and everything, and sometimes the installation of what's called hardware, which means pins and plates being attached to the bones.  Often the orthopedist will have to slice through or even resect tissue just to get his hands and his pliers on the non-aligned pieces of bone in order to reduce the fracture.  Mrs. Smith, of course, had to undergo an open reduction to set her left leg.

Non-union.  Mrs. Smith's leg was casted, and both lower leg bones were expected to show evidence of "knitting" (yes, that's the term doctors use) within a week or so, but every subsequent X-ray of the fibula showed, basically, no knitting.  Mrs. Smith was not healing.

I happened to be on my way to her room one day in the hospital, to maintain control of her like a good adjuster, when I overheard one of her nurses at the nurse's station discussing her case.  The nurse used the term "non-union," and although I didn't think much about it at the time, I later read up on it.  A "non-union" -- such an innocuous-sounding term -- is in fact a medical disaster, especially in a bone as big and important as the fibula.

Top of page

Reserving a case.  Now, to understand why I decided to impersonate a doctor in this case, you need to understand what's called "reserving a case."  All insurance companies are required by state law to set aside a certain amount of money -- basically cash -- for each claims file they open.  The amount of that reserve depends on the claims department's assessment of the likely total amount to be paid on that claim.  The reason is to make sure the insurance company can pay all its claims.

So, when you open a case file you put a reserve on it, and a percentage of that amount of money must be set aside by the insurance company in a highly liquid investment such as a short-term certificate of deposit.  The worse the injuries and the likelier it is that the insurance company will have to pay, the higher is the amount of money set aside.

And it's the setting aside of that money that costs insurance companies.  The reason is something you probably didn't know.

Many insurance companies happily endure what's called an "underwriting loss" every year.  An underwriting loss occurs when the amount of money taken in in premiums is less than the amount paid out on claims.  In the four years I worked for Liberty Mutual they suffered an underwriting loss every year.

Update of August 2004: According to this month's edition of Consumer Reports, page 36, "Over the last decade, insurers have paid an average of $1.17 in claims for every $1 they collected in premiums."

Needless to say, if that were the whole story then over the last decade your average insurer would be 17% bankrupt.

You probably thought what most people think, which is that insurance companies earn a profit from the huge number of premium dollars they take in for every policy they have to pay out on, and here's why you thought that: You thought: "I've been paying my premiums for the last ten years, at $1,000 a year, and when I finally did make a claim, all they paid was $6,000."  Good thought, but wrong.

You probably believed the explanation that says the insurance companies spread out the risk by paying out large sums but only infrequently, which benefits the big-dollar claimants who, in the absence of insurance, would be unable to collect in full.  Good thought, and not wrong, but incomplete.

For one thing, your piddly little auto policy premiums and your piddly little homeowner's policy premiums are as nothing compared to where the big money comes from, which is businesses and other organizations.  It's businesses that supply big insurance companies with the biggest part of their new capital.  Businesses such as carmakers and oil companies are where the big bucks come from.  If you are Dabney Driver, you pay maybe $500 to $1,000 in auto premiums a year, but if you're UPS, you pay millions.  And if you're UPS you pay millions more each year for Workers' Compensation insurance.  And if you're UPS you get special treatment from the claims department.  I know, because UPS was one of my policyholders.

So, anyway, you're probably asking yourself: If insurance companies keep taking in less in premiums than they pay out in claims, how can they stay in business? Good question, and here's the answer: Investments.

Investments.  Insurance companies own a much larger chunk of the planet than you probably think.

Update of December 12, 2006: According to an article in today's edition of The Kansas City Star, "U.S. insurance companies boast assets of $5.6 trillion."  That's enough to give us 300 million Americans nearly $19,000 each, or nearly $1,000 to all six billion of us on the planet.  That's the equivalent of the 2005 Gross Domestic Product of Japan and Canada combined.  That's a lot of money.

It is through shrewd investments that big insurance companies not only make up for those underwriting losses but make a substantial profit as well.  That's how insurance companies make money, not by taking in more in premiums than they pay out in claims but by having the power -- and the expertise -- to invest huge amounts of money successfully, often in long-term projects such as a shopping mall or a Saudi oil field.

And that's why insurance companies hate to over-reserve a case.   If a new case is reserved at $2,500 but it eventually pays out only $1,000, then that $1,500 is money the insurance company couldn't invest in something more profitable than a C.D.  On the other hand, if a case is under-reserved by $1,500 then the insurance company has more money to play with, more money that it can sink into long-term investments that pay better.  When you multiply that $1,500 by millions of claims each year, the cumulative under-reserving would allow the insurance company to perform even better in its true profit center, investments.

But the insurance commissions in the various states are charged with, among other things, making sure that cases are not under-reserved.  Because the insurance companies have a powerful incentive to keep as much money out of those low-paying reserve accounts as possible, the enforcement commissions conduct surprise inspections to see how accurately claims files are reserved, and if they find enough cases of under-reserving they can go so far as to make that company stop selling insurance in their state!  When you hear about an insurance company being shut down in a particular state, nine times out of ten it's for under-reserving, not for not paying claims.  It's juries and judges that make sure insurance companies pay claims; it's state insurance commissions that make sure they are able to.

Consequently, one of the continual jobs of a claims department is to update reserves.  If a claim looks like it won't cost as much as originally thought, the reserve may be lowered, which the insurance company just loves.  But if a claim looks like it's been under-reserved, state law in general and the insurance commission in particular require that additional money be set aside.

And that was the problem with Mrs. Smith's leg.

Top of page

Impersonating a doctor.  It was important for me to find out whether she did indeed have a non-union, because if she did I had to report that to my supervisor and explain to him how serious a non-union is, so he could instruct our home office to raise the reserve.

But I couldn't get anyone at the hospital to talk to me.  They cited doctor-patient privilege, and I couldn't get Mrs. Smith to sign a piece of paper, called a medical release, that would give the staff permission to talk to me.

So I decided to impersonate a doctor.

I showed up at the hospital unannounced and strode up to the nurse's station, confidently, confidently.  I told the head nurse I was there to do "a consult."  She asked me who the patient was, and I pretended to look up the name in a notebook.

"Mrs. Lydia Smith," I said.  "May I see her chart?"  Inside I was holding my breath, but outside I appeared imperious and impatient, just like so many real doctors.

She knew she had seen me there before, talking to Mrs. Smith, and without hesitation she found the chart, handed it to me, and said, "Here you are, Doctor."  She never even asked me my name.  God, that was fun, especially considering how bad it would have been if she'd caught me.  Not only would it be embarrassing as hell, it would have, no doubt, seriously damaged my relationship with my patient.

The final diagnosis.  It turns out that Mrs. Smith did indeed have a non-union of the left fibula, and the prognosis was not a well-healed fracture but an above-the-knee amputation!

I know more than the average bear about above-the-knee amputations.  Here's why.

After copying down certain information from her chart I went to see her in her room, and it was obvious no one had told her yet.  She was such a sweet, chipper little old lady -- talking about how she so looked forward to getting out of the hospital and getting healed and resuming her daily walks in the park just east of our insured's home -- that I couldn't bring myself to tell her.  I danced around the subject, hinting ever so obliquely that maybe she wouldn't be taking those walks any time soon.  I could see the fear, the uncertainty, in her eyes, and I could hear it in her voice.  I think she knew I knew something she didn't.  Part of me wanted to tell her that she would be losing her leg, just so she wouldn't be so much in the dark, but I couldn't bring myself to do it.  Instead I told her we'd be getting some more money to her, and that she might want to consider hiring an investment advisor to help her with it.  I didn't tell her what I was really thinking, which is that we'd be paying policy limits.

Policy limits.  Paying policy limits is an exceptionally rare occurrence, at least in my experience.  Indeed, this was the only case I worked on in four years in which we did it.  Paying policy limits means paying out all of the money available, all the coverage the insured bought.  In this case it was a pathetically low $350,000.

Tip from a former claims adjuster and amateur statistician: Consider buying higher liability coverage, both on your vehicles and your real property.  For a few extra dollars a year you can raise your liability coverage from the state-mandated minimum to, say, a million dollars.  As a claims adjuster, I'm here to tell you that it's possible to become liable for more than half a million dollars in obligations, which, if your policy is for only $350,000, means you might be going to work for some plaintiff for a good part of the rest of your life.  As an amateur statistician, I'm here to tell you that those few extra bucks a year, despite the extremely low probability of such a catastrophe, are well spent according to any reasonable payoff matrix, unless you're a gamblin' man.

When an insurance company decides to pay policy limits, things get rigorous.  First, that decision means there's no way to salvage a total payout of less than that amount, which even at $350,000 is a heck of a lot of money to even the biggest insurance company.  Second, it means the reserve must be raised to policy limits.  Third, it means that the insurance company is abandoning the policyholder, saying, in effect, "We have no more responsibility with regard to this occurrence."

"Reservation of rights."  Indeed, this last  reason is so serious that insurance companies send out a special letter -- called a "reservation of rights" letter -- to the policyholder.  The letter is sent by registered mail from the home office, with a return receipt requested just to make damned sure she can't later claim she didn't receive it.  The reservation of rights letter is written in court-tested legalese, and Beth's said in essence:

As a result of the accident on May 31, 1983, we have paid $350,000 to the claimant, Mrs. Lydia Smith, in the form of the following checks: [the payments are listed].  $350,000 is the highest amount we are obliged to pay under your policy number AL-404-12345.   We will make no further voluntary payments to anyone for any reason in this matter, and in particular we will no longer pay for your legal representation.

You are advised there is a possibility you are legally liable to Mrs. Smith for damages above and beyond the $350,000 we have paid, and we recommend you consider hiring your own lawyer at your own expense.

You are also advised that we reserve the right, according to the terms of your policy with us, to monitor any civil or criminal actions that arise or have arisen as a result of the occurrence.  We remind you that according to the terms of your policy, you are still obliged to provide us with any documents, pleadings, and other papers that are filed henceforth.

As I said earlier, insurance companies hate being forced to pay more than policy limits, such as for punitive damages.  It messes up their actuarial tables.

Anyway, we sent out the official reservation of rights letter to Beth, and I sent a copy to her lawyer just to cover the bases, and I totted up the damage.   We'd paid out $100,000 to or on behalf of Mrs. Smith, so a check for the remaining $250,000 was cut.

Top of page

My final act.  Once we had decided to pay policy limits, there was no reason to maintain control of the claimant, to keep her away from a lawyer, because we were out of it.  But I wanted to present Mrs. Smith with that check in person, so I got permission to hand-carry it to her.  I explained to her, as she was lying there in that dreary hospital room, that we had decided to pay out the maximum amount we could, that I wouldn't be seeing her any more, and that I had her final check.

When she saw how big it was, she was truly ecstatic.  She was thanking me, which made no sense, and she was talking about how she could leave something for her grandchildren, and all I could think about was how much she still didn't get it.

She still didn't get it that she had a lot more than $350,000 coming, that her medical bills alone ate up $100,000 of that so far and would eat up a lot more before she died.

She didn't get it that she deserved to be compensated for the months of pain and suffering she had already endured.

That she deserved to be compensated for the pain and suffering she would endure for years to come.

That she deserved to be compensated for the indisputable fact that Beth's negligence caused her to lose pretty much a whole entire leg and live the rest of her life that way.

When I realized how much Mrs. Smith had trusted me -- me, just doing my job -- that's when I decided to tell Mrs. Smith what I should have told her sooner.  I told her to go ahead and sue Beth -- beautiful, repentant but completely responsible Beth -- for all she's worth.

Mrs. Smith needed surgery.   I hereby offer to do free surgery on you.
  

 

  
The Projects
Mrs. Smith's leg
Free surgery
     Scalpels
     Trocar
Bad surgery
Margo Staples
     Police report
Ricky Taylor
"Listen carefully"
Honest scumbag
"It's my baby"
True story

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The Projects
Mrs. Smith's leg
Free surgery
     Scalpels
     Trocar
Bad surgery
Margo Staples
     Police report
Ricky Taylor
"Listen carefully"
Honest scumbag
"It's my baby"
True story

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The Projects
Mrs. Smith's leg
Free surgery
     Scalpels
     Trocar
Bad surgery
Margo Staples
     Police report
Ricky Taylor
"Listen carefully"
Honest scumbag
"It's my baby"
True story

 

  
The Projects
Mrs. Smith's leg
Free surgery
     Scalpels
     Trocar
Bad surgery
Margo Staples
     Police report
Ricky Taylor
"Listen carefully"
Honest scumbag
"It's my baby"
True story

 

B A R E L Y B A D  W E B  S I T E